Objective To investigate the clinical characteristics and etiology distribution of patients with acute
dizziness or vertigo in emergency department, to compare the difference in clinical characteristics
of central (CVS) and peripheral (PVS) vestibular system disease so as to effectively differentiate the
etiology of acute vertigo.
Methods From January 2017 to December 2018, patients with chief complaint of acute dizziness
or vertigo in emergency department were included in the study. Baseline demographic information,
medical history, routine examination, neurological examination, vestibular function examination,
radiographic data and final diagnosis were collected. Patients were divided into CVS or PVS group
according to the etiology diagnosis. The demographic information and clinical characteristics of the
two groups were compared.
Results A total of 660 patients (60.2% male, mean age 58.4±12.8 years) with acute dizziness or
vertigo were analyzed. 50-69 years were the age of high risk, and spring and winter were the peak
seasons. There were 422 cases in the CVS group and 238 cases in the PVS group. The proportion of
men (70.1% vs 42.4%, P <0.001), smokers (30.3% vs 9.2%, P <0.001), alcohol consumption (27.3%
vs 5.5%, P <0.001), the incidence of hypertension (59.7% vs 42.9%, P <0.001), dyslipidemia (18.5%
vs 12.2%, P =0.035), cerebrovascular disease (20.9% vs 10.9%, P =0.001), peripheral vascular
disease (7.3% vs 1.3%, P =0.001) and cardiovascular disease (5.5% vs 0.8 %, P =0.003) in CVS
group were significantly higher than that in PVS group. The age (60.19±12.77 years vs 57.44±12.73
years, P =0.008), and proportion of previous inner ear disease (5.9% vs 0.5%, P <0.001) in the PVS
group were higher than that in CVS group. For etiology diagnosis, in CVS group, 256 cases (60.7%)
for posterior circulation infarction, 87 (20.6%) for cerebral hemorrhage, 34 (8.1%) for subarachnoid
hemorrhage, 13 (3.1%) for vestibular migraine, 13 (3.1%) for transient ischemic attack, 9 (2.1%)
for cavernoma, 8 (1.9%) for tumor, 1 case (0.2%) for arnold-chiari malformation and 1 case (0.2%)
for multiple sclerosis; in PVS group, 121 cases (50.8%) for benign paroxysmal positional vertigo
(BBPV), 38 (16.0%) for Meniere's disease, 14 (5.9%) for vestibular neuronitis, 3 cases (1.3%) for
sudden deafness, and 62 cases (26.1%) with uncertain cause.
Conclusions For patients who presented with acute dizziness or vertigo in neurology emergency
department, posterior circulation infarction was the most common cause for CVS, and BBPV for
PVS. The patients with CVS were more likely to have vascular risk factors such as hypertension,
dyslipidemia, smoking, and drinking.
